Provider Demographics
NPI:1386952885
Name:VISION DEVELOPMENT CENTER OF MULLICA HILL NEW JERSEY
Entity type:Organization
Organization Name:VISION DEVELOPMENT CENTER OF MULLICA HILL NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-223-1626
Mailing Address - Street 1:10 BAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1504
Mailing Address - Country:US
Mailing Address - Phone:856-223-1626
Mailing Address - Fax:856-223-1626
Practice Address - Street 1:10 BAKER BLVD
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-1504
Practice Address - Country:US
Practice Address - Phone:856-223-1626
Practice Address - Fax:856-223-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTO00525152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty